Marijuana use, alcohol use, and sexual intercourse among truant adolescents.

BACKGROUND: Adolescence is a time in development when many initiate problem behaviors, including alcohol use, marijuana use, and sexual intercourse. Although research has shown that these behaviors tend to co-occur, little is known about their daily co-occurrences, particularly among high-risk groups such as truant adolescents. This study investigated the influence of marijuana and alcohol use on the odds of engaging in sexual intercourse on a daily level among a sample of truant adolescents. Methods: Daily-level data from 76 at-risk, truant adolescents (46 male, 30 female) between the ages of 13 and 19 years who reported alcohol use, marijuana use, and sexual intercourse over a 90-day retrospective recall period were analyzed. Results: General estimating equations analyzing 6840 days and controlling for age, gender, and school days demonstrated that the use of marijuana and/or alcohol on a given day were associated with significantly increased odds of engaging in sexual intercourse on the same day. A significant interaction suggested that marijuana use on a given day increased the odds of engaging in sexual intercourse on that day among occasional marijuana users, yet not among frequent users. Additionally, a significant interaction suggested that frequent alcohol users had higher odds of engaging in sexual intercourse than those who used alcohol less frequently. Conclusions: This study suggests that experimenting with marijuana and alcohol increases truant adolescents' odds of also engaging in sexual intercourse. These results bridge the gap in the literature by investigating the daily-level associations and frequency of substance use and sexual intercourse among truant adolescents. This study demonstrates that among truant adolescents, substance use and sexual intercourse do not function independently; therefore, it is important to address the intersection between substance use and sexual behaviors during intervention development if sustained behavioral change is expected.

Parent and Adolescent Motivational Enhancement Intervention for Substance-Using, Truant Adolescents: A Pilot Randomized Trial.

The purpose of this article is to present the results of a treatment development study designed to examine the feasibility, acceptability, and preliminary efficacy of motivational enhancement therapy (MET) for substance using, truant adolescents plus the Family Check-Up (FCU) for parents. A randomized controlled trial was used to test the hypothesis that MET plus the FCU (MET/FCU) would lead to greater reductions in alcohol and marijuana use as well as truant behavior compared to a psychoeducation (PE) condition delivered to both adolescents and parents. Participants (n = 69; M age = 15.8 years) were 39% female, 59% White, and 31% Hispanic/Latino. Adolescents were referred from family court, from school truancy courts, from school counselors, or after presentations in high school health classes. Eligible participants reported using marijuana at least 3 times in the prior 90 days and a history of school truancy in the prior school year. The MET/FCU condition was found to be feasible to implement and was acceptable to both adolescents and parents. The PE condition was also found to be an acceptable and credible comparison condition by participants. Results at the 6-month follow-up favored MET/FCU over PE on days of marijuana use and number of times marijuana was smoked per day (medium effect), high volume drinking days and other drug use (small to medium effects), truancy indicators (small effects), parental monitoring (medium to large effects), and parent-teen problem solving (medium to large effects). A larger study to test the efficacy of the MET/FCU appears warranted based on these promising findings.

Effects of a brief, parent-focused intervention for substance using adolescents and their sibling.

The purpose of this study was to evaluate the efficacy of the Family Check-up (FCU), a parent-focused brief motivational intervention, in families where parents were concerned about one adolescent's alcohol or marijuana use and the referred adolescent also had a sibling close in age. The primary goal of the FCU was to provide individualized feedback on specific parenting skills, including monitoring and supervision, limit setting, and alcohol-related communication. A total of 92 adolescents (37 female) between the ages of 12-19years of age along with a sibling (48 female) between the ages of 11-21years old, were randomized to the FCU or a psychoeducation (PE) comparison condition. Findings indicated that the FCU did not produce better effects on alcohol and other drug use outcomes than the PE condition, in either the adolescent or sibling. Brief interventions addressing parenting behaviors may not be sufficient to reduce alcohol use in adolescent drinkers not referred due to an alcohol-related incident. Future research might be conducted to explore whether brief parent interventions, such as those in the present study, could be useful as a preventive intervention for parents whose teens report low levels of substance use.

Moderators of Brief Motivation-Enhancing Treatments for Alcohol-Positive Adolescents Presenting to the Emergency Department.

A 2011 randomized controlled trial compared the effectiveness of two brief motivation-enhancing therapy (MET) models among alcohol-positive adolescents in an urban emergency department: adolescent MET-only versus MET + Family Check-Up (FCU), a parent MET model. Results indicated that among the 97 adolescents completing the 3-month assessment, both conditions were associated with reduced drinking and MET+FCU was associated with lower rates of high volume drinking than adolescent MET-only. The goal of this study was to identify predictors and moderators of high volume drinking in the original trial. Seven candidate variables were evaluated as moderators across three domains: demographic characteristics, psychological factors, and socio-contextual factors. Analyses of covariance models identified one significant predictor and one significant moderator of outcome. Older adolescents had significantly worse drinking outcomes than younger adolescents regardless of MET condition. Adolescents whose parents screened positive for problematic alcohol use at baseline had significantly worse drinking outcomes in the MET+FCU condition than the MET-only condition. Results indicate that alcohol-positive adolescents presenting to the emergency department may respond better to MET models if they are under the age of 16. Involving parents who have problematic alcohol use in a parent-focused MET may have negative effects on adolescent high volume drinking.